Ann Thorac Surg 2004;77:1955
© 2004 The Society of Thoracic Surgeons
Invited commentary
George V. Letsou, MD
Department of Cardiothoracic and Vascular Surgery University of Texas-Houston Medical School 6431 Fannin St, MSB 1.210 Houston, TX 77030, USA
e-mail: george.v.letsou{at}uth.tmc.edu
Pulmonary transplantation has become a widely accepted surgical treatment for a variety of end-stage lung diseases. Increasing survival rates, improved immunosuppression, and improved pulmonary preservation have all led to wide acceptance of lung transplantation by physicians, surgeons, and the general public. As techniques improve, the time to examine and improve other facets of the procedure has arrived.
Richard and colleagues from Montreal are to be congratulated for identifying and studying early post transplant pain control. Lung transplant recipients tend to be severely debilitated, malnourished, and under a high degree of stress. All these factors may be important in the genesis of substantial pain that many lung transplant recipients experience in the early postoperative period. In their study, Richard and colleagues compared patients undergoing single lung transplantation via a standard posterolateral thoracotomy to patients undergoing bilateral lung transplantation via a transverse thoracosternotomy ("clamshell" incision), to patients undergoing posterolateral thoracotomy for indications other than transplantation. They confirmed (as might be expected by lung transplant surgeons) that patients undergoing lung transplantation have significantly more difficulty with pain relief and control than patients undergoing thoracotomy for other indications. They also have significantly more difficulty transitioning from epidural anesthesia. Surprisingly, patients undergoing a "clamshell" incision did not experience more pain than patients undergoing a standard thoracotomy for lung transplantation; emphasizing that the condition of the patient, rather than the type of incision, is the dominant factor in pain control after lung transplantation. Although the study is retrospective, and has all the limitations of any retrospective study, these significant findings emphasize the importance of adequate and early postoperative pain control after pulmonary transplantation. Improved pain control permits early mobilization, prevents pulmonary complications, and allows for improved recuperation.
Control of postoperative pain after lung transplantation can be significantly improved. Studies such as this are elegant guides for such improvement.
